Claim by Jeff PowersMasterpiece on the Mississippi
TRACEY STECKLEIN
PARALEGAL
MEMORANDUM
To: Mayor Roy D. Buol and
Members of the City Council
DATE: June 27, 2011
RE: Claim Against the City of Dubuque by Jeff Powers
Claimant Date of Claim Date of Loss
Jeff Powers 06/22/11 06/21/11
This is a claim in which claimant alleges that a landfill employee
claimant's truck with the handle of a cart the employee was using
trailer.
This claim has been referred to Public Entity Risk Services of Iowa,
Communities Assurance Pool.
cc: Michael C. Van Milligen, City Manager
Doug Hughes, DMASWA Facility Supervisor
Jeff Powers
Nature of Claim
Vehicle Damage
scratched the side of
to unload paint from a
the agent for the Iowa
OFFICE OF THE CITY ATTORNEY DUBUQUE, IOWA
SUITE 330, HARBOR VIEW PLACE, 300 MAIN STREET DUBUQUE, IA 52001 -6944
TELEPHONE (563) 583 -4113 / FAx (563) 583 -1040 / EMAIL tsteckle @cityofdubuque.org
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2. Address:
3. Telephone Number
4. Date of Incident:
8. What were weather conditions like?
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RECEIVED
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA JUN 22 Aft 10 24
This written report constitutes your claim against the City of Dubuque, Iowa. YoCity `� (it1L°
should complete this form in full and attach any additional information that Dubuque, IA
supports your claim.
The claim must be filed with the City Clerk at City Hall, 50 West 13 St.,
Dubuque, IA 52001. It will then be referred to the appropriate department for
investigation and to the City Attorney's Office. Once that investigation is
completed, a report and recommendation will be submitted to the City Council.
You will be provided with a copy of that report and recommendation.
The final decision on all claims is made by the City Council. No employee of the
City of Dubuque has the authority to make any representation to you as to
whether your claim will or will not be paid.
1. Name of Claimant: Ql? fF / (/fi/e{r5
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5. Time of Incident: /a.'
6. Location of Incident (Be specific):
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7. Describe the accident or occurrence that caused injury or damage. (Give full
details upon which you base your claim. If a City employee was involved, give
the er ee name.) r' T TA l—,/94/9 / 7 L S cr.�-TT'/ co
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9. Give name and address of any witnesses:
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10. Did police investigate? (If so, give names of officers.)
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11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If so, describe property and the extent
of damages. Attach estimates of damages or describe basis for ascertaining
extent of damage.)
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13. What other damages do you claim, if any?
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14. Have you been compensated for any part or all of your claim by any
insurance company? (If so, give name and address of insurance company and
amount paid.)
(Print Name)
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15. What amount do you claim from the City of Dubuque? it
16. Why do you claim the City of Dubuque is responsible?
FIG- Pei' GiviIL- D/p 1 e PA - e
17, Have you made any claim against anyone else for damages as a result of
this incident? (If yes, give name and address.)
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18. If the answer to Question 17 is yes, have you received any payment from that
source, and if so, in what amount?
Dated is 2-1 d_ .f ,T 114/..e_ , 20 j / .
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